Gay and bisexual men in UK warned of Shigella outbreak

Gay and bisexual men in the UK are being targeted with a new
health information campaign warning them about a serious gut infection.

The joint Public Health England (PHE) and Terrence Higgins
Trust (THT) campaign informs gay/bisexual men about the risks and symptoms of
Shigella dysentery.

The infection is spread through oral-faecal contact and is
usually linked to foreign travel. In 2009 there were only 43 cases among men in
the UK that didn’t have a link to travel. But the number surged to 224 cases in 2013, and further reports are
expected.

“Shigella is on the rise, so it is vital gay and bisexual
men know about it and how to avoid getting it,” said Dr Gwenda Hughes, head of
STI surveillance at PHE.

Posters and leaflets informing men about the infection are
being distributed to nightclubs, saunas and bars and other gay venues, as well
as sexual health clinics.

Shigella is a bacterial gut infection that causes severe,
prolonged diarrhoea and stomach cramps. In gay and bisexual men, it is spread
through oral contact with faeces, either directly due to sexual activities such
as rimming (oral-anal contact) or via unwashed hands. Only tiny amounts of the
bacteria can transmit the infection.

Symptoms usually develop one to three days after infection and
include:

Frequent diarrhoea lasting more than 48 hours.

Stomach cramps.

Feeling feverish.

Vomiting.

Feeling weak and tired.

The infection can pose a serious health risk to HIV-positive
individuals with weak immune systems.

Gay and bisexual men are being urged to avoid oral-faecal
contact and to wash their hands thoroughly and shower after sex.

The potential severity of the symptoms is apparent in the
experiences of one gay man who acquired the infection via rimming. “Getting Shigella
was the lowest point of my life,” he said. “I suffered uncontrollable bloody
diarrhoea with severe stomach cramps. The severity of the symptoms and dehydration
headaches made me think I was going to die.”

Gay and bisexual men experiencing Shigella symptoms are
urged to go to their GP or a clinic, mentioning Shigella and requesting a stool
sample test.

The infection is treatable with antibiotics.

Interviews with men diagnosed with the infection have
identified several risk factors:

High numbers of anonymous sexual partners met
online or at sex parties.

Use of drugs during sex, including mephedrone,
methamphetamine, ketamine and GBL.

Injecting drug use.

Most of the men with Shigella were also diagnosed with
another sexually transmitted infection or HIV. “This is a reminder of how
important it is to use a condom when having sex with casual and new partners,”
said Hughes. “The Shigella awareness campaign is part of a broader commitment
to helping improve the health of gay and bisexual men, including exploring the
links between health and drug use. The level of injecting drug use is a
particular concern as we know it puts men at greatly increased risk of
blood-borne viruses such as HIV and hepatitis C.”

Cary James, head of health improvement at THT, expressed
concern that not all cases of the infection were being reported. “Men with
symptoms who haven’t heard of Shigella before might assume it’s a particularly
bad case of food poisoning,” he said. “However, the infection can be dangerous,
even more so if you’re already living with HIV or hep C.”

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.